Extracorporeal membrane oxygenation for COVID-19 and influenza H1N1 associated acute respiratory distress syndrome: a multicenter retrospective cohort study

Vito Fanelli, Marco Giani, Giacomo Grasselli, Francesco Mojoli, Gennaro Martucci, Lorenzo Grazioli, Francesco Alessandri, Silvia Mongodi, Gabriele Sales, Giorgia Montrucchio, Costanza Pizzi, Lorenzo Richiardi, Luca Lorini, Antonio Arcadipane, Antonio Pesenti, Giuseppe Foti, Nicolò Patroniti, Luca Brazzi, VMarco Ranieri, Vito Fanelli, Marco Giani, Giacomo Grasselli, Francesco Mojoli, Gennaro Martucci, Lorenzo Grazioli, Francesco Alessandri, Silvia Mongodi, Gabriele Sales, Giorgia Montrucchio, Costanza Pizzi, Lorenzo Richiardi, Luca Lorini, Antonio Arcadipane, Antonio Pesenti, Giuseppe Foti, Nicolò Patroniti, Luca Brazzi, VMarco Ranieri

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) has become an established rescue therapy for severe acute respiratory distress syndrome (ARDS) in several etiologies including influenza A H1N1 pneumonia. The benefit of receiving ECMO in coronavirus disease 2019 (COVID-19) is still uncertain. The aim of this analysis was to compare the outcome of patients who received veno-venous ECMO for COVID-19 and Influenza A H1N1 associated ARDS.

Methods: This was a multicenter retrospective cohort study including adults with ARDS, receiving ECMO for COVID-19 and influenza A H1N1 pneumonia between 2009 and 2021 in seven Italian ICU. The primary outcome was any-cause mortality at 60 days after ECMO initiation. We used a multivariable Cox model to estimate the difference in mortality accounting for patients' characteristics and treatment factors before ECMO was started. Secondary outcomes were mortality at 90 days, ICU and hospital length of stay and ECMO associated complications.

Results: Data from 308 patients with COVID-19 (N = 146) and H1N1 (N = 162) associated ARDS who had received ECMO support were included. The estimated cumulative mortality at 60 days after initiating ECMO was higher in COVID-19 (46%) than H1N1 (27%) patients (hazard ratio 1.76, 95% CI 1.17-2.46). When adjusting for confounders, specifically age and hospital length of stay before ECMO support, the hazard ratio decreased to 1.39, 95% CI 0.78-2.47. ICU and hospital length of stay, duration of ECMO and invasive mechanical ventilation and ECMO-associated hemorrhagic complications were higher in COVID-19 than H1N1 patients.

Conclusion: In patients with ARDS who received ECMO, the observed unadjusted 60-day mortality was higher in cases of COVID-19 than H1N1 pneumonia. This difference in mortality was not significant after multivariable adjustment; older age and longer hospital length of stay before ECMO emerged as important covariates that could explain the observed difference.

Trial registration number: NCT05080933 , retrospectively registered.

Keywords: ARDS; COVID-19; ECMO; H1N1; Influenza.

Conflict of interest statement

None of the authors have financial or non-financial interests that are directly or indirectly related to the present work.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Kaplan-Mayer survival curves for COVID-19 and influenza A H1N1 patients
Fig. 2
Fig. 2
Cox model of factors accounting for differences in 60-day mortality after ECMO in patients with COVID-19 versus influenza A H1N1

References

    1. Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, Hibbert CL, Truesdale A, Clemens F, Cooper N, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374(9698):1351–1363. doi: 10.1016/S0140-6736(09)61069-2.
    1. Patroniti N, Zangrillo A, Pappalardo F, Peris A, Cianchi G, Braschi A, Iotti GA, Arcadipane A, Panarello G, Ranieri VM, et al. The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks. Intensive Care Med. 2011;37(9):1447–1457. doi: 10.1007/s00134-011-2301-6.
    1. Noah MA, Peek GJ, Finney SJ, Griffiths MJ, Harrison DA, Grieve R, Sadique MZ, Sekhon JS, McAuley DF, Firmin RK, et al. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1) JAMA, J Am Med Assoc. 2011;306(15):1659–1668. doi: 10.1001/jama.2011.1471.
    1. Fowler RA, Lapinsky SE, Hallett D, Detsky AS, Sibbald WJ, Slutsky AS, Stewart TE, Toronto SCCG. Critically ill patients with severe acute respiratory syndrome. JAMA. 2003;290(3):367–373. doi: 10.1001/jama.290.3.367.
    1. Zangrillo A, Biondi-Zoccai G, Landoni G, Frati G, Patroniti N, Pesenti A, Pappalardo F. Extracorporeal membrane oxygenation (ECMO) in patients with H1N1 influenza infection: a systematic review and meta-analysis including 8 studies and 266 patients receiving ECMO. Crit Care. 2013;17(1):R30. doi: 10.1186/cc12512.
    1. Piroth L, Cottenet J, Mariet AS, Bonniaud P, Blot M, Tubert-Bitter P, Quantin C. Comparison of the characteristics, morbidity, and mortality of COVID-19 and seasonal influenza: a nationwide, population-based retrospective cohort study. Lancet Respir Med. 2021;9(3):251–259. doi: 10.1016/S2213-2600(20)30527-0.
    1. Henry BM, Lippi G. Poor survival with extracorporeal membrane oxygenation in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19): Pooled analysis of early reports. J Crit Care. 2020;58:27–28. doi: 10.1016/j.jcrc.2020.03.011.
    1. Roedl K, Jarczak D, Thasler L, Bachmann M, Schulte F, Bein B, Weber CF, Schafer U, Veit C, Hauber HP, et al. Mechanical ventilation and mortality among 223 critically ill patients with coronavirus disease 2019: A multicentric study in Germany. Aust Crit Care. 2021;34(2):167–175. doi: 10.1016/j.aucc.2020.10.009.
    1. Barbaro RP, MacLaren G, Boonstra PS, Iwashyna TJ, Slutsky AS, Fan E, Bartlett RH, Tonna JE, Hyslop R, Fanning JJ, et al. Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry. Lancet. 2020;396(10257):1071–1078. doi: 10.1016/S0140-6736(20)32008-0.
    1. Schmidt M, Hajage D, Lebreton G, Monsel A, Voiriot G, Levy D, Baron E, Beurton A, Chommeloux J, Meng P, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: a retrospective cohort study. Lancet Respir Med. 2020;8(11):1121–1131. doi: 10.1016/S2213-2600(20)30328-3.
    1. Ramanathan K, Shekar K, Ling RR, Barbaro RP, Wong SN, Tan CS, Rochwerg B, Fernando SM, Takeda S, MacLaren G, et al. Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis. Crit Care. 2021;25(1):211. doi: 10.1186/s13054-021-03634-1.
    1. Schmidt M, Bailey M, Sheldrake J, Hodgson C, Aubron C, Rycus PT, Scheinkestel C, Cooper DJ, Brodie D, Pellegrino V et al: Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score. Am J Respir Crit Care Med 2014, 189(11):1374–1382.
    1. Investigators AI, Webb SA, Pettila V, Seppelt I, Bellomo R, Bailey M, Cooper DJ, Cretikos M, Davies AR, Finfer S, et al. Critical care services and 2009 H1N1 influenza in Australia and New Zealand. N Engl J Med. 2009;361(20):1925–1934. doi: 10.1056/NEJMoa0908481.
    1. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, Cereda D, Coluccello A, Foti G, Fumagalli R, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region Italy. JAMA. 2020;323(16):1574–1581. doi: 10.1001/jama.2020.5394.
    1. MacLaren G, Combes A, Brodie D. What's new in ECMO for COVID-19? Intensive Care Med. 2021;47(1):107–109. doi: 10.1007/s00134-020-06284-z.
    1. Abrams D, Lorusso R, Vincent JL, Brodie D. ECMO during the COVID-19 pandemic: when is it unjustified? Crit Care. 2020;24(1):507. doi: 10.1186/s13054-020-03230-9.
    1. Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, Forrest P, Gattas D, Granger E, Herkes R et al: Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA 2009, 302(17):1888–1895.
    1. Karagiannidis C, Strassmann S, Merten M, Bein T, Windisch W, Meybohm P, Weber-Carstens S: High in-hospital mortality in COVID patients receiving ECMO in Germany - a critical analysis. Am J Respir Crit Care Med 2021.
    1. Schmidt M, Pham T, Arcadipane A, Agerstrand C, Ohshimo S, Pellegrino V, Vuylsteke A, Guervilly C, McGuinness S, Pierard S et al: Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome. an international multicenter prospective cohort. Am J Respir Crit Care Med 2019, 200(8):1002–1012.
    1. Cousin N, Bourel C, Carpentier D, Goutay J, Mugnier A, Labreuche J, Godeau E, Clavier T, Grange S, Tamion F, et al. SARS-CoV-2 versus influenza-associated acute respiratory distress syndrome requiring veno-venous extracorporeal membrane oxygenation support. ASAIO J. 2021;67(2):125–131. doi: 10.1097/MAT.0000000000001325.
    1. Giani M, Martucci G, Madotto F, Belliato M, Fanelli V, Garofalo E, Forlini C, Lucchini A, Panarello G, Bottino N et al: Prone positioning during venovenous extracorporeal membrane oxygenation in acute respiratory distress syndrome. a multicenter cohort study and propensity-matched analysis. Ann Am Thorac Soc 2021, 18(3):495–501.
    1. Rozencwajg S, Guihot A, Franchineau G, Lescroat M, Brechot N, Hekimian G, Lebreton G, Autran B, Luyt CE, Combes A, et al. Ultra-protective ventilation reduces biotrauma in patients on venovenous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. Crit Care Med. 2019;47(11):1505–1512. doi: 10.1097/CCM.0000000000003894.
    1. Combes A, Hajage D, Capellier G, Demoule A, Lavoue S, Guervilly C, Da Silva D, Zafrani L, Tirot P, Veber B, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378(21):1965–1975. doi: 10.1056/NEJMoa1800385.

Source: PubMed

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